右锁骨下静脉穿刺置管术改进的解剖依据和临床验证

Anatomic basis of modified right subdavian vein catheterization and its clinical significance

目的:为改进右锁骨下静脉穿刺置管术的操作方法提供解剖学基础,并通过临床应用加以验证。方法:20具成人标本,按改进穿刺点定位的具体操作步骤,解剖观察右锁骨下静脉的行程、毗邻,测量与该静脉有关的数据;并用该法行右锁骨下静脉穿刺中心静脉置管术2 180例。结果:穿刺点至右锁骨下静脉、右锁骨下动脉和静脉角的距离分别为（3.5±0.6）cm,（2.9±0.6）cm和（5.7±0.9）cm,锁骨表面至第一肋表面的深度为（2.3±0.4）cm,锁骨下缘与锁骨下静脉的角度为37.5°±11.6°。统计了按此置管术施行的临床资料2180例,穿刺成功率为98.85％（2155例）;穿刺失败率为 1.15％（25例）,并分析了失败的原因。结论:改进的右锁骨下静脉穿刺术具有成功率高的特点,值得推广应用。

Objective: To provide anatomic basis and to verify clinical applications for modifying the primitive procedures of the right subclavian vein catheterization. Methods: Anatomical observation and measurement of the right subclavian vein and its adjacent to structures were performed on 20 adult specimens according to modified procedures. And 2180 cases of the right subclavian vein catheterization were carried out by using the modified procedure. Results: The anatomical studied showed that the distances from the perforating point to right subclavian vein, right subclavian artery and venous angle are 3.5 ± 0.6 cm, 2.9 ± 0.6 cm and 5.7 ± 0.9 cm, respectively, and the depth from the clavicle and the surface of the rib is 2.3 ± 0.4 cm, while the angle between lower ridge of the clavicle and the right subclavian vein is 73.5°± 11.6°. The clinical data revealed that the total of 2180 cases operations were performed of which the successful rate is 98.85% (2155 cases) and the failure ones is 1.15% (25 cases) . And the causes of the failure was analyzed. Conclusion: The modified right subclavian vein catheterization was characterized by highly successful rate and is worth popularizin.